Perioperative Medicine 💊

A 40 year old woman attends the pre-operative clinic as she is going to undergo a hysterectomy for the management of fibroids. Which of the following investigations are appropriate to be requested in the clinic?

A 39 year old woman attends the hospital for an elective lumpectomy under general anaesthesia for suspected breast cancer. Her surgery is scheduled for 11 am. She ate her breakfast with a milky coffee at 7 am and continued with clear fluids until 10 am. What is the most appropriate action?

A 43 year old diabetic, who takes regular sitagliptin, has a planned elective hernia repair surgery. What is the SINGLE most appropriate advice to give regarding the perioperative management of his diabetic medication?

A 39 year old type 2 diabetic is planning to undergo an elective major surgery. He takes long-acting insulin and gliclazide. What is the SINGLE most appropriate pre-op management?

A 44 year old man with a history of type 2 diabetes mellitus is due for an elective endoscopy for investigation of Helicobacter pylori next week. His diabetes is well controlled with gliclazide which he takes twice a day over the past 5 years. What is the SINGLE most appropriate advice in regards to his diabetic management?

A 61 year old woman fell down her stairs and sustained a fractured neck of femur. She is admitted in the hospital and has her surgery booked for the following day. Her blood test shows the following:

Haemoglobin 77 g/L (115-160)

Mean cell volume 71 fL (76-96)

Mean cell haemoglobin concentration 300 g/L (300-360)

Platelets 160 x 10″/L (150-400)

What is the SINGLE most appropriate next action?

A 56 year old man presents for a surgical consultation. He has an inguinal hernia that has persisted for the past 6 months, and he would like to undergo surgery for the same. The consultant decided that the patient may undergo an elective herniorrhaphy as a day case procedure, and having counselled the patient about the procedure, directed the patient for a pre-anaesthetic check. On evaluation, the patient reports that he had a myocardial infarction 6 weeks ago and underwent stenting for the same. Additionally, he developed a pulmonary embolism 2 years ago, which required hospitalisation and was diagnosed with diabetes mellitus around the same time. On assessment, his heart rate was 96 beats per minute, and blood pressure was 170/90 mmHg. His laboratory reports are available.

HbA1c 68 mmol/mol (<48)

Haemoglobin 128 g/L (130-180)

Which of the following is an absolute contraindication to surgery?

A 55 year old man has been admitted for an elective herniorrhaphy. He has a history of asthma which he takes salbutamol and inhaled corticosteroids. He was admitted twice to ICU for asthma exacerbations 10 and 12 months ago. His medical history includes a myocardial infarction 2 months ago. His BMI is 31 kg/m2. He has a deep vein thrombosis 2 years ago. He has a blood pressure of 155/95 mmHg. Which among the following is the SINGLE most likely reason to postpone his surgery?

A 38 year old man underwent a left total nephrectomy a few hours ago for renal cell carcinoma. He now complains of feeling unwell. The wound dressing is heavily soaked with blood and there is blood all over the bedsheets as well. He has a heart rate of 121 beats/minute, blood pressure of 74/40 mmHg and a respiratory rate of 30 breaths/minute. After the administration of 1 litre of 0.9% normal saline, his blood pressure rises to 100/70 mmHg. What is the most appropriate intravenous resuscitation for this patient?

A 47 year old man who is on warfarin therapy is due for a hemicolectomy. He is an warfarin for recurrent pulmonary embolism. What advice would you give him prior to his surgery?

A 65 year old man with advanced and poorly controlled Crohn’s disease was evaluated by the gastroenterology and surgery team and has been advised to undergo an ileocaecal resection. He was diagnosed with atrial fibrillation three years ago and is on warfarin for the same. His medical history is significant for hypertension. Which of the following is the SINGLE best option for the perioperative preparation of this patient?

A 62 year old man attends the pre-assessment clinic. He is due for an elective total hip replacement in 6 weeks’ time. He takes apixaban 5mg twice a day. He tells you he was started on this after it was found that he had a problem with his heart rate. What advice would you provide him regarding how to manage his apixaban peri-operatively?

A 68 year old man attends the pre-assessment clinic. He is due a revision of his total hip replacement in 6 weeks’ time. ‘Previous PE and DVT are stated in his notes and on questioning him he states he was re-admitted to the hospital a week after his last hip replacement 10 years ago with a swollen leg. He takes apixaban Smg twice a day. He tells you he was started on this after receiving a diagnosis of atrial fibrillation 5 years ago. What advice would you give regarding how to manage his apixaban peri- operatively?

A 57 year old woman attends the pre-operative clinic as she is going to undergo a right hip arthroplasty. She has no comorbidities. Which of the following investigations are appropriate to be requested in the clinic?

A 59 year old man is seen in the pre-operative clinic as he on the elective list for a hip arthroplasty. He has a mechanical mitral valve and is on warfarin. Which of the following is the best option for the perioperative preparation of this patient?